Most healthy individuals make an uneventful recovery. Although it's difficult to resist scratching the itchy rash, it is best to keep hands off, to prevent a bacterial infection that may require antibiotic treatment. After an infection, the skin may be left with significant scarring, which may be serious enough to require plastic surgery.
Another complication, Ramsay Hunt syndrome, occurs when the varicella-zoster virus spreads to the facial nerve, causing facial paralysis, intense ear pain and vesicles in the auditory canal and outer ear structures (auricle). The rash might appear on the outer ear, inside the ear canal, on the soft palate (part of the roof of the mouth), or around the mouth and on the face, neck, and scalp. The hearing loss, vertigo, and facial paralysis that may result are usually, but not always, temporary.
Occasionally, the rash will appear as a single spot or cluster of spots on the tip of the nose. This symptom is called Hutchinson's sign. The ophthalmic nerve is often involved and the eye may become affected, causing temporary or permanent blindness. If the eye is affected (ophthalmic herpes) or looks like it may become affected, an eye specialist (ophthalmologist) should be consulted.
Shingles is a serious threat to immunosuppressed individuals — for example, those with HIV infection, individuals who are receiving cancer treatments and those that have received organ transplants. In those whose immune systems are extremely weakened, the varicella zoster virus can also spread to the internal organs and affect the lungs, central nervous system and the brain, possibly leading to death.